Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

NON-ROUTINE BL DRAW 3/> YRS

Facility

$40.76

Service Code	HCPCS 36410
Hospital Charge Code	16000342
Hospital Revenue Code	360
Min. Negotiated Rate	$0.98
Max. Negotiated Rate	$1,626.00
Rate for Payer: Aetna Commercial	$15.49
Rate for Payer: Aetna Medicare Advantage	$12.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$10.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$10.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,626.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$10.39
Rate for Payer: Cigna Commercial	$20.38
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$12.23
Rate for Payer: Qualcare PPO/HMO/WC	$6.11
Rate for Payer: UnitedHealthcare Community & State	$0.98
Rate for Payer: Wellpoint Medicaid Managed Care	$1.08

NON ROUTINE BLOOD DRAW > 3YRS

Facility

$46.15

Service Code	HCPCS 36410
Hospital Charge Code	5100088
Hospital Revenue Code	361
Min. Negotiated Rate	$1.11
Max. Negotiated Rate	$1,626.00
Rate for Payer: Aetna Commercial	$17.54
Rate for Payer: Aetna Medicare Advantage	$13.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$11.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$11.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,626.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$11.77
Rate for Payer: Cigna Commercial	$23.07
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$13.85
Rate for Payer: Qualcare PPO/HMO/WC	$6.92
Rate for Payer: UnitedHealthcare Community & State	$1.11
Rate for Payer: Wellpoint Medicaid Managed Care	$1.22

NON ROUTINE BLOOD DRAW > 3YRS

Facility

$46.15

Service Code	HCPCS 36410
Hospital Charge Code	5100088
Hospital Revenue Code	361
Min. Negotiated Rate	$6.92
Max. Negotiated Rate	$6.92
Rate for Payer: Qualcare PPO/HMO/WC	$6.92

NONSPECIFIC CEREBROVASCULAR DISORDERS WITH CC

Facility

$35,296.12

Service Code	MSDRG 071
Min. Negotiated Rate	$10,747.22
Max. Negotiated Rate	$35,296.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$24,656.66
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$24,656.66
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$24,656.66

NONSPECIFIC CEREBROVASCULAR DISORDERS WITH MCC

Facility

$55,943.19

Service Code	MSDRG 070
Min. Negotiated Rate	$17,033.98
Max. Negotiated Rate	$55,943.19
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$41,637.19
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$41,637.19
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$41,637.19

NONSPECIFIC CEREBROVASCULAR DISORDERS WITHOUT CC/MCC

Facility

$26,575.72

Service Code	MSDRG 072
Min. Negotiated Rate	$8,091.97
Max. Negotiated Rate	$26,575.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$18,143.58
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$18,143.58
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$18,143.58

NONSPECIFIC CVA AND PRECEREBRAL OCCLUSION WITHOUT INFARCTION

Facility

$9,820.45

Service Code	APR-DRG 0462
Min. Negotiated Rate	$9,627.89
Max. Negotiated Rate	$9,820.45
Rate for Payer: UnitedHealthcare Community & State	$9,627.89
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$9,820.45
Rate for Payer: Wellpoint Medicaid Managed Care	$9,627.89

NONSPECIFIC CVA AND PRECEREBRAL OCCLUSION WITHOUT INFARCTION

Facility

$12,350.90

Service Code	APR-DRG 0463
Min. Negotiated Rate	$12,108.73
Max. Negotiated Rate	$12,350.90
Rate for Payer: UnitedHealthcare Community & State	$12,108.73
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$12,350.90
Rate for Payer: Wellpoint Medicaid Managed Care	$12,108.73

NONSPECIFIC CVA AND PRECEREBRAL OCCLUSION WITHOUT INFARCTION

Facility

$8,199.01

Service Code	APR-DRG 0461
Min. Negotiated Rate	$8,038.25
Max. Negotiated Rate	$8,199.01
Rate for Payer: UnitedHealthcare Community & State	$8,038.25
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$8,199.01
Rate for Payer: Wellpoint Medicaid Managed Care	$8,038.25

NONSPECIFIC CVA AND PRECEREBRAL OCCLUSION WITHOUT INFARCTION

Facility

$24,111.95

Service Code	APR-DRG 0464
Min. Negotiated Rate	$23,639.17
Max. Negotiated Rate	$24,111.95
Rate for Payer: UnitedHealthcare Community & State	$23,639.17
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$24,111.95
Rate for Payer: Wellpoint Medicaid Managed Care	$23,639.17

NONSPECIFIC CVA AND PRECEREBRAL OCCLUSION WITHOUT INFARCTION WITH MCC

Facility

$49,604.88

Service Code	MSDRG 067
Min. Negotiated Rate	$15,104.05
Max. Negotiated Rate	$49,604.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$33,030.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$33,030.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$33,030.62

NONSPECIFIC CVA AND PRECEREBRAL OCCLUSION WITHOUT INFARCTION WITHOUT MCC

Facility

$30,072.87

Service Code	MSDRG 068
Min. Negotiated Rate	$9,156.80
Max. Negotiated Rate	$30,072.87
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$20,237.07
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$20,237.07
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$20,237.07

NONTRAUMATIC STUPOR AND COMA WITH MCC

Facility

$60,636.26

Service Code	MSDRG 080
Min. Negotiated Rate	$18,462.97
Max. Negotiated Rate	$60,636.26
Rate for Payer: Aetna Medicare Advantage	$60,636.26
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$51,406.81
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$51,406.81
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$19,434.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$51,406.81
Rate for Payer: Cigna Commercial	$33,872.34
Rate for Payer: Cigna Medicare Advantage	$19,434.70
Rate for Payer: Clover Medicare Advantage	$18,462.97
Rate for Payer: EmblemHealth Commercial	$58,304.10
Rate for Payer: Humana Medicare Advantage	$20,017.74
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$19,434.70
Rate for Payer: Oxford Commercial	$24,344.50
Rate for Payer: UnitedHealthcare Commercial	$42,688.85
Rate for Payer: UnitedHealthcare Medicare Advantage	$19,434.70
Rate for Payer: Wellcare Medicare Advantage	$19,434.70

NONTRAUMATIC STUPOR AND COMA WITHOUT MCC

Facility

$31,081.35

Service Code	MSDRG 081
Min. Negotiated Rate	$9,463.87
Max. Negotiated Rate	$31,081.35
Rate for Payer: Aetna Medicare Advantage	$31,081.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$21,167.51
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$21,167.51
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$9,961.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$21,167.51
Rate for Payer: Cigna Commercial	$16,760.26
Rate for Payer: Cigna Medicare Advantage	$9,961.97
Rate for Payer: Clover Medicare Advantage	$9,463.87
Rate for Payer: EmblemHealth Commercial	$29,885.91
Rate for Payer: Humana Medicare Advantage	$10,260.83
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$9,961.97
Rate for Payer: Oxford Commercial	$12,045.82
Rate for Payer: UnitedHealthcare Commercial	$21,122.73
Rate for Payer: UnitedHealthcare Medicare Advantage	$9,961.97
Rate for Payer: Wellcare Medicare Advantage	$9,961.97

NORCURON/10MG

Facility

$131.00

Hospital Charge Code	60633541
Hospital Revenue Code	250
Min. Negotiated Rate	$19.65
Max. Negotiated Rate	$19.65
Rate for Payer: Qualcare PPO/HMO/WC	$19.65

NORCURON/10MG

Facility

$131.00

Hospital Charge Code	60633541
Hospital Revenue Code	250
Min. Negotiated Rate	$3.16
Max. Negotiated Rate	$65.50
Rate for Payer: Aetna Commercial	$49.78
Rate for Payer: Aetna Medicare Advantage	$39.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$33.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$33.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$33.41
Rate for Payer: Cigna Commercial	$65.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$39.30
Rate for Payer: Oxford Commercial	$26.20
Rate for Payer: Qualcare PPO/HMO/WC	$19.65
Rate for Payer: UnitedHealthcare Commercial	$26.20
Rate for Payer: UnitedHealthcare Community & State	$3.16
Rate for Payer: Wellpoint Medicaid Managed Care	$3.47

NOREPINEPBITART NS 16MG/250ML

Facility

$201.00

Service Code	NDC 70092146805
Hospital Charge Code	606390482
Hospital Revenue Code	250
Min. Negotiated Rate	$4.84
Max. Negotiated Rate	$100.50
Rate for Payer: Aetna Commercial	$76.38
Rate for Payer: Aetna Medicare Advantage	$60.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$51.26
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$51.26
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$51.26
Rate for Payer: Cigna Commercial	$100.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$60.30
Rate for Payer: Oxford Commercial	$40.20
Rate for Payer: Qualcare PPO/HMO/WC	$30.15
Rate for Payer: UnitedHealthcare Commercial	$40.20
Rate for Payer: UnitedHealthcare Community & State	$4.84
Rate for Payer: Wellpoint Medicaid Managed Care	$5.33

NOREPINEPBITART NS 16MG/250ML

Facility

$201.00

Service Code	NDC 70092146805
Hospital Charge Code	606390482
Hospital Revenue Code	250
Min. Negotiated Rate	$30.15
Max. Negotiated Rate	$30.15
Rate for Payer: Qualcare PPO/HMO/WC	$30.15

NOREPINEPH BETR INJ 1MG/ML 4ML

Facility

$95.40

Hospital Charge Code	6003990
Hospital Revenue Code	250
Min. Negotiated Rate	$2.30
Max. Negotiated Rate	$47.70
Rate for Payer: Aetna Commercial	$36.25
Rate for Payer: Aetna Medicare Advantage	$28.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$24.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$24.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$24.33
Rate for Payer: Cigna Commercial	$47.70
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$28.62
Rate for Payer: Oxford Commercial	$19.08
Rate for Payer: Qualcare PPO/HMO/WC	$14.31
Rate for Payer: UnitedHealthcare Commercial	$19.08
Rate for Payer: UnitedHealthcare Community & State	$2.30
Rate for Payer: Wellpoint Medicaid Managed Care	$2.53

NOREPINEPH BETR INJ 1MG/ML 4ML

Facility

$95.40

Hospital Charge Code	6003990
Hospital Revenue Code	250
Min. Negotiated Rate	$14.31
Max. Negotiated Rate	$14.31
Rate for Payer: Qualcare PPO/HMO/WC	$14.31

NOREPINEPHRINE 1MG/ML

Facility

$25.00

Hospital Charge Code	60635632
Hospital Revenue Code	250
Min. Negotiated Rate	$0.60
Max. Negotiated Rate	$12.50
Rate for Payer: Aetna Commercial	$9.50
Rate for Payer: Aetna Medicare Advantage	$7.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$6.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$6.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$6.38
Rate for Payer: Cigna Commercial	$12.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$7.50
Rate for Payer: Oxford Commercial	$5.00
Rate for Payer: Qualcare PPO/HMO/WC	$3.75
Rate for Payer: UnitedHealthcare Commercial	$5.00
Rate for Payer: UnitedHealthcare Community & State	$0.60
Rate for Payer: Wellpoint Medicaid Managed Care	$0.66

NOREPINEPHRINE 1MG/ML

Facility

$25.00

Hospital Charge Code	60635632
Hospital Revenue Code	250
Min. Negotiated Rate	$3.75
Max. Negotiated Rate	$3.75
Rate for Payer: Qualcare PPO/HMO/WC	$3.75

NOREPINEPHRINE 4MG/250ML NS

Facility

$53.60

Service Code	NDC 75901120204
Hospital Charge Code	606390109
Hospital Revenue Code	250
Min. Negotiated Rate	$8.04
Max. Negotiated Rate	$8.04
Rate for Payer: Qualcare PPO/HMO/WC	$8.04

NOREPINEPHRINE 4MG/250ML NS

Facility

$53.60

Service Code	NDC 75901120204
Hospital Charge Code	606390109
Hospital Revenue Code	250
Min. Negotiated Rate	$1.29
Max. Negotiated Rate	$26.80
Rate for Payer: Aetna Commercial	$20.37
Rate for Payer: Aetna Medicare Advantage	$16.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$13.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$13.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$13.67
Rate for Payer: Cigna Commercial	$26.80
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$16.08
Rate for Payer: Oxford Commercial	$10.72
Rate for Payer: Qualcare PPO/HMO/WC	$8.04
Rate for Payer: UnitedHealthcare Commercial	$10.72
Rate for Payer: UnitedHealthcare Community & State	$1.29
Rate for Payer: Wellpoint Medicaid Managed Care	$1.42

NOREPINEPHRINE 4 MG / 4 ML INJ

Facility

$70.35

Service Code	NDC 36000016210
Hospital Charge Code	60627463
Hospital Revenue Code	250
Min. Negotiated Rate	$1.70
Max. Negotiated Rate	$35.17
Rate for Payer: Aetna Commercial	$26.73
Rate for Payer: Aetna Medicare Advantage	$21.11
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$17.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$17.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$17.94
Rate for Payer: Cigna Commercial	$35.17
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$21.11
Rate for Payer: Oxford Commercial	$14.07
Rate for Payer: Qualcare PPO/HMO/WC	$10.55
Rate for Payer: UnitedHealthcare Commercial	$14.07
Rate for Payer: UnitedHealthcare Community & State	$1.70
Rate for Payer: Wellpoint Medicaid Managed Care	$1.86

Know your out-of-pocket cost for care.

All Charges